Hallazgos microbiológicos y susceptibilidad antimicrobiana en cirugía abdominal de urgencia / Microbiological findings and antimicrobial susceptibility in emergency abdominal surgery

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Linfoma de Burkitt en pacientes HIV positivo tratados con quimioterapia intensiva en el Hospital del Salvador entre 2011 y 2014: Protocolo Nacional de Cáncer del Adulto, Chile / Intensive chemotherapy for Burkitt lymphoma in HIV positive patients

Background: Burkitt lymphoma has a low incidence, is highly aggressive, may be endemic, sporadic or associated with immunodeficiency and it has a high frequency of extranodal involvement. Overall and relapse free survival in HIV patients is 72 and 71% respectively. However, the current protocol in Chile considers a positive HIV serology as an exclusion criterion for intensive chemotherapy. Aim: To analyze the response to Burkitt lymphoma treatment among HIV positive patients. Material and Methods: All HIV positive patients with a Burkitt lymphoma treated using PANDA protocol in a public hospital were analyzed. Results: Eight male patients aged between 25 and 43 years, 63% in stage IV, were analyzed. All patients received an intensified chemotherapy regime, three of them without Rituximab. Complete remission was achieved in 87%. One patient was refractory to treatment and one patient relapsed at 5 months and died. Overall and relapse free survival were 58 and 60% respectively. All patients had episodes of high risk febrile neutropenia, but it did not cause deaths. Conclusions: In this group of HIV patients, intensive chemotherapy for Burkitt lymphoma had a high degree of effectiveness with a low relapse rate and high cure rate.

Avaliação da atividade antimicrobiana do extrato etanólico bruto da casca da sucupira branca (Pterodon emarginatus Vogel) - Fabaceae / Evaluation of antimicrobial activity of crude ethanol extract from the bark of "sucupira branca" (Pterodon emarginatus Vogel) - Fabaceae

Pterodon emarginatus Vogel (Fabaceae) é uma árvore do Cerrado conhecida popularmente como "sucupira branca, faveiro, fava de sucupira e sucupira lisa" e utilizada na medicina popular em preparações anti-reumáticas, antiinflamatórias, analgésicas e antiinfecciosas. Esse trabalho teve por objetivo fazer a triagem fitoquímica do pó e avaliar a atividade antimicrobiana do extrato etanólico bruto das cascas da P. emarginatus contra bactérias Gram-positivas, Gram-negativas e o fungo Candida albicans. O extrato etanólico bruto foi obtido a partir das cascas dessecadas e pulverizadas. A concentração inibitória mínima (CIM) do extrato bruto foi determinada utilizando-se o inoculador de Steers. Os testes fitoquímicos detectaram a presença de flavonóides, heterosídeos saponínicos, resinas e traços de esteróides e triterpenóides. As CIM do extrato etanólico foram de 0,18 mg mL-1 para as bactérias Gram-positivas Rhodococcus equi ATCC 25923, Micrococcus luteus ATCC 9341, Micrococcus roseus IPTSP/UFG e para as bactérias Gram-negativas Serratia marcescens ATCC 14756 e Pseudomonas aeruginosa ATCC 9027; de 0,37 mg mL-1 para a Enterobacter cloacae FT 505 LEMC/EPM/UFG e de 0,74 mg mL-1 para as demais bactérias testadas e para o fungo C. albicans. O presente estudo abre perspectivas para o uso da cascas da P. emarginatus como antimicrobiano.

Pterodon emarginatus Vogel (Fabaceae) is a Cerrado tree popularly known as "sucupira branca", "faveiro", "fava de sucupira" and "sucupira lisa" and has been used in folk medicine as antirheumatic, anti-inflammatory, analgesic and anti-infective. The aim of this work was to perform the phytochemical screening of the powder and to evaluate the antimicrobial activity of crude ethanol extract from P. emarginatus barks against Gram-positive bacteria, Gram-negative bacteria and the fungus Candida albicans. The crude ethanol extract was obtained from desiccated and pulverized barks. Its minimum inhibitory concentration (MIC) was determined by using Steers inoculator. The phytochemical tests detected the presence of flavonoids, saponin heterosides, resins and traces of steroids and triterpenoids. Ethanol extract MICs were 0.18 mg mL-1 for the Gram-positive bacteria Rhodococcus equi ATCC 25923, Micrococcus luteus ATCC 9341 and Micrococcus roseus IPTSP/UFG, and for the Gram-negative bacteria Serratia marcescens ATCC 14756 and Pseudomonas aeruginosa ATCC 9027; 0.37 mg mL-1 for Enterobacter cloacae FT 505 LEMC/EPM/UFG; and 0.74 mg mL-1 for the remaining tested bacteria and for the fungus C. albicans. This study opens perspectives for the use of P. emarginatus barks as an antimicrobial drug.

Evaluación prospectiva de pacientes con SDRA con sospecha de infección por influenza a H1N1 en terapia intensiva. Seguimiento a los 30 días del alta / Prospective evaluation of patients with ARDS with suspected H1N1 influenza infection in intensive therapy. Follow-up 30 days after discharge

El objetivo del presente es la caracterización de pacientes en terapia intensiva en el hospital de alta complejidad, y portadores de insuficiencia respiratoria aguda con requerimiento de asistencia ventilatoria mecánica, a su vez, el comportamiento de pacientes con infección por el virus influenza H1N1 que desarrollan síndrome de dificultad respiratorio agudo (SDRA).

Análise da atividade antimicrobiana das folhas de Davilla elliptica St.-Hil. (Dilleniaceae) / Investigation of antimicrobial activity of Davilla elliptica St.-Hil. leaves (Dilleniaceae)

Davilla elliptica St.-Hil. (Dilleniaceae) é um arbusto,usado popularmente como adstringente, tônico, sedativo, diurético, no tratamento de hemorróidas, hérnia e em aplicações tópicas como anti-séptico na limpeza de ferimentos. O presente estudo teve por objetivo avaliara atividade antimicrobiana dos extratos etanólicos brutos das folhas de D. elliptica coletadas em Alexânia e Goiânia, Goiás, Brasil. Os extratos etanólicos brutos foram obtidos, por maceração a frio, a partir das folhas dessecadas e pulverizadas. A atividade antimicrobiana foi avaliada utilizando 25 cepas de microrganismos (Gram-negativos, Gram-positivos e levedura) através da determinação da Concentração Inibitória Mínima (CIM) utilizando-se o inoculador de Steers. Os extratos obtidos de plantas coletados nas duas localidades inibiram o crescimento de todas as cepas avaliadas. O extrato da amostra coletada em Alexânia apresentou atividade antimicrobiana com CIM variando de 0,371 mg/mL a 0,743 mg/mL. O extrato da amostra coletada em Goiânia apresentou CIM variando de < 0,023 mg/mL a 11,9 mg/mL. Os extratos etanólicos brutos das folhas de D. elliptica foram mais ativos contra as bactérias Gram-positivas do que para as bactérias Gram-negativas.

Davilla elliptica St.-Hil.(Dilleniaceae) is a shrub, whose leaves are traditionally used in Brazilian popular medicine as an astringent, tonic, sedative and diuretic and to treat hemorrhoids and hernia and it is applied a topical antiseptic to clean wounds. The aim in this study was to assess the antimicrobial activity of crude ethanol extracts of D. elliptica leaves collected in the towns of Alexânia and Goiânia, state of Goiás, Brazil. The crude extracts were obtained by cold maceration, of the dried and pulverized leaves in ethanol. Antimicrobial activities against 25 strains of microorganisms (Gram-negative bacteria, Gram-positive bacteria and a yeast) were tested determining by the Minimal Inhibitory Concentration (MIC) in agar plates inoculated with using a Steers replicator. Extracts of from inhibited the growth of all strains evaluated. The extract of the sample collected in Alexânia showed antimicrobial activity with MICs ranging from 0.371 mg/mL to 0.743 mg/mL, while that collected in Goiânia showed MICs ranging from <0.023 mg/mL to 11.9 mg/mL. The D. elliptica crude leaf ethanol extracts evaluated were more active against Gram-positive than Gram-negative bacteria.

Avaliação da atividade antimicrobiana das partes aéreas (folhas e caules) e raízes de Richardia brasiliensis Gomez (Rubiaceae) / Assessment of antimicrobial activity of aerial parts (leaves and stems) and roots of Richardia brasiliensis Gomez (Rubiaceae)

Richardia brasiliensis é uma planta utilizada popularmente como expectorante, emética, diaforética, vermífuga e para o tratamento de hemorróidas. O presente estudo objetivou realizar a prospecção fitoquímica e avaliar a ação antimicrobiana do extrato bruto das partes aéreas e raízes de R. brasiliensis. O extrato etanólico bruto foi obtido a partir do material botânico dessecado e pulverizado. O pó das partes aéreas e raízes foram submetidos à triagem fitoquímica. A atividade antimicrobiana foi realizada contra bactérias Gram-positivas esporuladas e não esporuladas, Gram negativas e a levedura Candida albicans através da determinação da concentração inibitória mínima por diluição em ágar empregando-se o inoculador de Steers. A triagem fitoquímica evidenciou a presença de esteróides, triterpenóides, cumarinas, resinas, alcaloides e flavonóides. A CIM do extrato das partes aéreas variou de 0,37 a 0,74 mg/mL e das raízes de 0,74 a 11,9 mg/mL. Concluiu-se que tanto o extrato etanólico bruto das partes aéreas quanto das raízes apresentaram atividade antimicrobiana.

Richardia brasiliensis is a neotropical perennial her bused in Brazilian popular medicine as an expectorant, emetic, diaphoretic, vermifuge and to treat hemorrhoids. This paper reports the phytochemical screening and the antimicrobial activity of crude ethanol extracts of the aerial parts and roots of this plant. The crude ethanol extracts were prepared from dried, pulverized botanical material. The aerial parts and roots powder was screened for classes of phytochemicals. The antimicrobial activity was tested against spore-forming and non-sporing Gram-positive bacteria, Gramnegative bacteria and Candida albicans by the agardilution method, inoculating the series of plates at multiple points with a Steers replicator to determine the minimum inhibitory concentration (MIC) of each organism. The phytochemical screening showed the presence of steroids, triterpenes, coumarins, resins, alkaloids and flavonoids. The MIC of the extract of aerial parts varied from 0.37 to 0.74 mg/mL and that of the roots from 0.74 to 11.9 mg/mL. It was concluded that the crude ethanolic extracts of both the aerial parts and the roots showed antimicrobial activity.

Linfoma de células B de la zona marginal extranodal del tejido linfoide asociado a mucosas (malt) primario de esófago: Presentación de un caso

El tracto gastrointestinal es la localización mas frecuente de los linfomas no Hodgkin extranodales, sin embargo, el compromiso del esófago es extremadamente raro, con una incidencia menor del 1% de todos los pacientes con linfoma. Se ha descrito con mayor frecuencia afectación secundaria del esófago como parte de un compromiso extenso de un linfoma gástrico o mediastinal. Se presenta el caso de paciente femenina, de 59 años de edad, con síntomas dispépticos de 2 meses de evolución. En la Endoscopia Digestiva Superior (EDS) se evidencia en tercio distal de esófago, lesión elevada, de 1cm de diámetro, con características similares al resto de la mucosa, móvil. La biopsia Endoscópica revela la presencia de un linfoma MALT de bajo grado confirmado por inmunohistoquímica. Se indicó tratamiento de erradicación para H pylori, y los estudios de extensión fueron normales. Posteriormente se realizó resección mucosal endoscópica, donde se observaron grupos aislados de linfocitos neoplásicos, con bordes de resección libres. Paciente con seguimiento endoscópico normal. Pocos casos han sido reportados en la literatura acerca de linfomas MALT de esófago, por lo tanto las características clínicas y biológicas de estos linfomas no están claramente establecidas. Es necesario el estudio y seguimiento de estos casos, para determinar los posibles factores de riesgo y así aplicar las medidas preventivas.

The gastrointestinal tract is the most common extra nodal site involved in Non- Hodgkin's lymphoma. However, esophageal involvement is extremely rare, accounting for less than 1% of patients with lymphoma. It has been described that esophageal involvement in lymphoma is more often a result of contiguous spread from mediastinal lymph nodes or from an extended gastric lymphoma. A 59 year old female consulted for dyspeptic symptoms. Endoscopic examination revealed a small submucosal mass, that measured 1 cm located at the lower thoracic esophagus. The biopsy reported a Malt lymphoma that was confirmed by immunohistochemistry. She received therapy for H. pylori eradication. Endoscopic mucosal resection was performed, and isolated groups of atypical lymphocytes were found, with free resection margins. Endoscopic follow up has been normal. Few cases have been reported in literature, therefore biological and clinical characteristics of MALT lymphoma of the esophagus are currently unknown, further study is needed to establish risk factors in order to be able to take preventive measures.

Carcinoma gástrico precoz mucinoso: Reporte de un caso y revisión de la literatura

El carcinoma gástrico mucinoso (CGM) es infrecuente representa el 3% de todos los canceres gástricos (1). Detectado ocasionalmente en estadios precoces (2), con una relación avanzados/precoces de 2.1 - 2.3% y 0.3 - 1.0% respectivamente (1, 2). Correspondiendo el CGM en estadio precoz al 0.02 de todos los carcinomas gástricos. Se reporta este inusual caso de paciente femenina de 72 años de edad quien consultó por síntomas dispépticos, se hizo el diagnóstico histológico de ADC gástrico, por biopsia endoscópica, siendo sometida a gastrectomía subtotal, y cuyo reporte definitivo de la pieza quirúrgica fue CGM precoz, con compromiso submucoso, sin evidencia de ganglios metastáticos.

Mucinous gastric cancer (MGC) is very rare. The incidence of MGC is about 3% among all gastric cancers and only occasionally detected in early -stage with a relation between advanced and early gastric cancer around 2.3- 21% and 0.3- 1% respectively. Early-stage mucinous gastric cancer represents 0.02 of all gastric cancer types. We report an unusual case of a 72 years old female patient with histological diagnosis of gastric Adenocarcinoma. A total gastrectomy was performed. Final diagnosis was that of an early mucinous gastric cancer involving the submucosal layer without lymph node metastasis.

Caracterização farmacognóstica de folhas de Davilla elliptica St.-Hil. (Dilleniaceae) / Pharmacognostic characterization of the leaves of Davilla elliptica St.-Hil. (Dilleniaceae)

Davilla elliptica St.-Hil. é empregada popularmente no tratamento de hemorróidas, diarréias e ferimentos. O propósito deste trabalho foi realizar o estudo farmacognóstico de folhas de D. elliptica de dois locais do Estado de Goiás. Cortes paradérmicos e transversais foram submetidos a técnicas usuais de microscopia óptica. As folhas de D. elliptica são hipoestomáticas, sendo os estômatos predominantemente paracíticos. Na epiderme observam-se tricomas unicelulares em ambas faces. O mesofilo é isobilateral e apresenta idioblastos cristalíferos. O sistema vascular na nervura principal é constituído por três feixes vasculares, formando uma estrutura circular. No pecíolo o sistema vascular apresenta uma estrutura circular formada, provavelmente, pela união de vários feixes vasculares. O material pulverizado foi submetido a testes de prospecção fitoquímica, de pureza e quantitativo. Foi constatada a presença de taninos, cumarinas, resinas, flavonóides, saponinas, esteróides e triterpenóides. Os teores de cinzas totais foram de 10,32 por cento e 12,26 por cento; os de cinzas insolúveis em ácido, 7,46 por cento e 9,68 por cento; e os de umidade, 9,92 por cento e 9,50 por cento. Os teores de flavonóides totais foram de 1,20 por cento e 1,48 por cento, e os de taninos 9,89 por cento e 13,96 por cento. Devido ao número reduzido de amostras, não é possível afirmar, através deste estudo, que o perfil farmacognóstico de D. elliptica seja influenciado por fatores abióticos.

Davilla elliptica St.-Hil. is popularly used in the treatment of hemorrhoid, diarrhea and wounds. The aim of this work was to characterize pharmacognosticaly two leaves samples of D. elliptica. Paradermal and transversal sections had been submitted the usual techniques of optical microscopy. The leaves of D. elliptica are hypostomatics, and the stomata predominantly paracytic. In both epidermis were observed unicellular non-glandular trichomes. The mesophyll is isolateral and shows idioblasts with crystals in raphide. The vascular system in the midrib is constituted by three vascular bundles, forming a circular structure. The petiole shows a circular structure probably formed by union of many vascular bundles localized in the central region. The powdered plant material was submitted to tests of phytochemical prospection, of purity and quantitative. There had been evidenced the presence of tannins, coumarins, resins, flavonoids, saponins and steroids. The content of total ashes was of 10,32 percent and 12,26 percent, insoluble in acid of 7,46 percent and 9,68 percent; the humidity of 9,92 percent and 9,50 percent. The flavonoids contents was of 1,20 percent and 1,48 percent; the tannins contents was of 9,89 percent and 13,96 percent. Because of the reduced number of samples, it was not possible to affirm through this study that the pharmacognostic profile de D. elliptica is influenced by abiotics factors.